Time for Pharmacare

[Argus]

Another study has come out showing that Canadians could save billions every year if we had government paid pharmacare. It reiterates what others have said, that our individual payer system means we pay far more for prescription drugs than other countries around the world whose government schemes buy in bulk and get big discounts. I don't see the downside on this one. And plenty of upside if it's done right.

Canadians and private drug-plan sponsors could save more than $4-billion a year if the federal government adopted universal coverage for a group of commonly prescribed essential medicines, according to a new analysis in the Canadian Medical Association Journal.

The study, published Monday, used economic modelling to determine the government would have to spend an estimated $1.2-billion a year to provide universal coverage for 117 essential medicines, which accounted for 44 per cent of the prescriptions filled in Canada in 2015. Individuals and private plans would save nearly $4.3-billion if such a system were introduced, according to the economic modelling used in the study.

 

http://www.theglobeandmail.com/news/national/with-universal-drug-coverage-canadians-could-save-billions-study/article34141670/?reqid=92443554-9252-4edd-9ba4-af13ae25373b

[cannuck]

I can hear the Yanks screaming their heads off about socialism, but big pharma, big med, big finance and big law have consistently proven to be unworthy of public trust.  The general public deserves protection from their treachery.  However, this goes a step beyond.   Where the US is so screwed up, and Canada mimics their mistakes is in thinking sick care is a business.  It is not.  It is a social service.  It is a crucial service to having a productive economy, and there is no GOOD reason that government shouldn;t be using their muscle to bulk purchase and deliver drugs to its citizens.  All ideological BS aside, that just good business.

[kimmy]

11 hours ago, Argus said:

Another study has come out showing that Canadians could save billions every year if we had government paid pharmacare. It reiterates what others have said, that our individual payer system means we pay far more for prescription drugs than other countries around the world whose government schemes buy in bulk and get big discounts. I don't see the downside on this one. And plenty of upside if it's done right.

I think there's two separate issues. One is universal drug coverage, and the other is a national drug-purchase strategy.  They're not necessarily linked together. We could have one, the other, or both.

The idea of universal drug coverage tends to get some peoples' hackles up, because it could potentially be very expensive.

The idea of a national drug purchase strategy, on the other hand, should be welcomed by everybody except, perhaps, those who own shares in drug companies. I heard this being discussed on the radio recently in regard to a drug that's potentially life-changing for people with Hepatitis C.   In Canada, it's prohibitively expensive, and provincial health plans can't cover it because the extreme high cost would crush the healthcare system.   In Australia, on the other hand, the drug is available for patients.  Why the difference?  Australia has a national drug purchasing plan, which allowed them to negotiate a much better price than Canadians can get buying drugs as individuals.   From what I heard during the radio segment, I gather that Canada is the only country with a universal healthcare system that doesn't also have a national drug purchasing system.

Even without universal drug coverage, such a system could make a big impact in the price of medicine for Canadians, and could potentially save the healthcare system vast sums of money as well.  I can't think of a good reason not to do it.

 -k

[bush_cheney2004]

6 hours ago, cannuck said:

I can hear the Yanks screaming their heads off about socialism, but big pharma, big med, big finance and big law have consistently proven to be unworthy of public trust. 

 

So when will all the Canadian socialists start spending/investing the billions of dollars in R&D costs to develop such drugs compared to the "Yanks".

 

[Michael Hardner]

5 hours ago, bush_cheney2004 said:

 

So when will all the Canadian socialists start spending/investing the billions of dollars in R&D costs to develop such drugs compared to the "Yanks".

 

I spoke to a Professor with knowledge of Pharmacare and he asserted that the testing process is so onerous, that it drives up R&D costs to a prohibitive level.  Trump, I understand, rightly sees this as a quagmire that can be fixed to lower drug prices.  This is the insight that only a businessman could offer: take what appears to be a politically untouchable option (reducing testing) and rethink it, thereby addressing the root of the problem.  

[kimmy]

6 hours ago, bush_cheney2004 said:

So when will all the Canadian socialists start spending/investing the billions of dollars in R&D costs to develop such drugs compared to the "Yanks".

Luckily American consumers are willing to pay for all that!  America: land of the brave, home of the $600 Epi-Pen!

R&D on epinephrine was finished in the 1970s, but was apparently so expensive that American Dutch/Irish drug company Mylan was forced to increase the price by 500% in the past couple of years.

Gilead are, of course, free to not sell their Hepatitis cure to Australia's government at the price they've negotiated, but Gilead has apparently decided that a reduced margin is better than zero customers. In the meantime, there must be enough wealthy Americans who can pay full price for a Hepatitis cure to make it worthwhile for Gilead. Tommy Lee, Pam Anderson...

-k

[?Impact]

8 hours ago, bush_cheney2004 said:

So when will all the Canadian socialists start spending/investing the billions of dollars in R&D costs to develop such drugs compared to the "Yanks".

Yes, Canadian drug companies are falling way behind in R&D investment. It is time to take away that intellectual property protections they want, although with NAFTA and now CETA that will be hard. I had a neighbor that was heavily involved in the industry several years ago and she said a lot of the focus was on clinical testing and not basic research, but even that was drying up quickly. The real leaders are Switzerland, Germany, Italy, the U.K, France and Sweden.

[bush_cheney2004]

3 hours ago, ?Impact said:

Yes, Canadian drug companies are falling way behind in R&D investment.

 

Agreed...and not surprised that many Canadians want somebody else to pay for it.  

Canada has long been a laggard for public and private investment in R&D...no wonder so many want to limit IP rights for development in other nations.

[Argus]

13 hours ago, kimmy said:

I think there's two separate issues. One is universal drug coverage, and the other is a national drug-purchase strategy.  They're not necessarily linked together. We could have one, the other, or both.

The idea of universal drug coverage tends to get some peoples' hackles up, because it could potentially be very expensive.

I look at this from the perspective that there is only one payer, the taxpayer. If we have to raise taxes a bit to afford pharmacare I say we should do it. I get what you mean, and I agree with it, but I think we should have pharmacare for the same reason we have health care. If you need a heart drug to stay alive then it has to be paid for.

But I agree, that if we can't get pharmacare we should at least have a national drug purchase system. We're currently paying the highest costs for prescriptions in the world save only the crazy Americans. We need to get those costs down. I saw an interview with the Liberal health minister the other day on this, though, and she didn't seem to care much about it and had little interest in the idea.

 

 

[cannuck]

Just as I said, the Yanks not able to tell the difference between business and social services.

[SpankyMcFarland]

How is it that the UK's NHS, so often derided in North America, can afford a national prescription drug program and we can't? UK doctors are surprised when they come here to find the working poor unable to afford drugs they prescribe. 

[Topaz]

My late  hubby had a argument with our drug store because we have drug coverage  from the company he worked for and when he turn 65, the store wanted him to go on the Ontario plan for seniors, which would cost  2.00 vs .35 cent, which add to the Ontario tax payers vs that company paying most of the coverage. Coverage like that should be a choice or if one has private coverage its should be first. Thoughts?

[Argus]

12 hours ago, SpankyMcFarland said:

How is it that the UK's NHS, so often derided in North America, can afford a national prescription drug program and we can't? UK doctors are surprised when they come here to find the working poor unable to afford drugs they prescribe. 

It's not that we can't afford it. We, as a people, as a nation, are paying more for these drugs than we would be under a national program. But to work well we need a national system. And we haven't had a federal government with any vision or interest on health care in at least thirty years. All they want to do is not get bad press about it and lay all the blame on the provinces whenever it doesn't work well. They certainly don't want to initiate a new program which might cost them money - even if it saves Canadians money.

Edited March 4, 2017 by Argus

[BillyBeaver]

I think that the top 50-100 curative drugs in use should be part of a pharmacare program. The program should be reviewed every year or two to see which drugs are being used the most and the government should negotiate a deal for better pricing. Only the most effective drugs should be considered.

 Should opioids or boner enhancers be on that list? Hell no.

Edited March 10, 2017 by BillyBeaver

[?Impact]

1 minute ago, BillyBeaver said:

I think that the top 50-100 curative drugs in use should be part of a pharmacare program.

Often physicians have a wide range of options to prescribe for any condition. It is not perfect, but sometimes they will choose a more effective option or one that is easier to administer*. Would having a limited number of drugs on the list cause them to focus on those drugs and not what in their opinion is a better option?

---

*tangent

There are a lot of examples of different forms of administering a drug having significant cost consequences, but probably the most common of these is the Epipen. Those can cost up to $500 or more, and of course have an expiry date so you end up throwing them out in a few months. An ampule of epinephrine and a small bore syringe might cost you $20 (or even much less in quantity). Of course the Epipen is over the counter, and the epinephrine is prescription thanks to marketing. Certainly those who have known severe allergic reactions should carry around an Epipen, and hopefully they have an insurance plan that covers it (although that raises the cost for all group plans) but nobody is going to equip their first aid kit with Epipens that will most likely be tossed out at several hundred dollars per year. It is a concern to those of us who lead multi-day wilderness trips, and usually on a volunteer basis.

[BillyBeaver]

This is where free market competition comes in. You take a few from Pfizer and few from Merck, few from Glaxo Smith Kline, a pharmacare program means that certain drugs will be given preference over others. Any one of these companies can make an epi-pen. We have buying power of 40 million people plus a subsidized healthcare system. Surely one of them will play ball. Canada enforces controlled monopolies almost as a rule. The problem is finding medical professionals and politicians that aren't bought and paid for by Big Pharma that will make neutral, rational scientific decisions about which options are best for Canadians. Government needs to remember that it is the gatekeeper, not the ticket booth operator. Businesses exist at our leisure, time to make NAFTA work for us for a change.

[dre]

I couldn't agree more with Argus here.

Here's an example...

Quote

 

The best systems have a national formulary (list of drugs covered) with single purchaser paying power, says Steve Morgan, a health policy professor at the University of British Columbia. New Zealand has a much smaller population than Canada, but negotiates brand-name drug prices that are about 40 per cent lower and generic drug prices that are 90 per cent lower than Canadian prices because it buys medications as a country.

“Almost all universal public health-care systems operate with a version of a single national formulary …With this, you can negotiate pricing terms and guarantee supplies. Canada doesn’t have that. As a result, we are the silver medallists when it comes to high prices in pharmaceuticals.”

 

I think Canada and the US are the worst simply because corporate cronyism and quid pro quo politics are so pervasive. Big companies tell the government to jump and the government says "how high?" And we have signed trade deals that are written almost completely by industry representatives that tie our hands.

If the government DID take meaningful steps to lower prices, they would probably be dragged in front of some international trade court and sued for damages by big pharmy.

[BillyBeaver]

Let them sue. In the meantime we will be making medications more accessible to Canadians.

[Argus]

10 hours ago, BillyBeaver said:

I think that the top 50-100 curative drugs in use should be part of a pharmacare program. The program should be reviewed every year or two to see which drugs are being used the most and the government should negotiate a deal for better pricing. Only the most effective drugs should be considered.

 Should opioids or boner enhancers be on that list? Hell no.

You realize that opiates are prescribed for pain, right? Sometimes intense, continuing pain from terrible diseases. People have been known to commit suicide because of being unable to take continuing pain, day after day after day.

[Argus]

9 hours ago, dre said:

I couldn't agree more with Argus here.

Here's an example...

I think Canada and the US are the worst simply because corporate cronyism and quid pro quo politics are so pervasive. Big companies tell the government to jump and the government says "how high?" And we have signed trade deals that are written almost completely by industry representatives that tie our hands.

If the government DID take meaningful steps to lower prices, they would probably be dragged in front of some international trade court and sued for damages by big pharmy.

Given that almost every other country in the western world does the universal buyer thing to lower prices I don't see how we could be dragged in front of any sort of tribunal. Other countries pay far less than us, and have been for years. Canada has to have a hell of a lot more buying power than New Zealand, so why are their drugs cheaper than ours? Why do we have the most expensive prescription drugs in the world outside the US?

[BillyBeaver]

Because of the big pharma lobby keeping our politicians from making any real changes.

 

Oxycontin and fentanyl do more damage than good when used outside of a controlled, medical setting. They are selling those naloyone (sp!) whatever kits to combat fentanyl overdoses now. They go for hundreds of dollars a pop. Hmmm manufacture a crisis and then sell a band-aid cure, gogo Big Pharma!

I don't want a country of opiate addicts, go hang out in the lower east side of Van for proof why.

[Argus]

12 minutes ago, BillyBeaver said:

Because of the big pharma lobby keeping our politicians from making any real changes.

 

Oxycontin and fentanyl do more damage than good when used outside of a controlled, medical setting. They are selling those naloyone (sp!) whatever kits to combat fentanyl overdoses now. They go for hundreds of dollars a pop. Hmmm manufacture a crisis and then sell a band-aid cure, gogo Big Pharma!

I don't want a country of opiate addicts, go hang out in the lower east side of Van for proof why.

You realize most of the fentanyl is being imported from China, right? It's not coming from cancer patients taking them for their pain. Do you want to have people living in agony in favor of trying to stop idiotic drug abusers from accidentally killing themselves?

 

[BillyBeaver]

I want our medical system to explore all alternatives to addictive pharmaceuticals. They should be a last resort applied in controlled medical settings. pain is natural, it reminds you you're alive. Physicians have been overprescribing opiates for the last decade. We are reaping the consequences.

Of course, some patients deserve the strongest pain medicines, but the hippocratic oath still should apply.

 

And yes, i'm aware that a lot of it is coming from Pacific rim countries, the profit margins are incredibly high. You can make 200k profit on one kilo of fentanyl.

[?Impact]

44 minutes ago, Argus said:

You realize most of the fentanyl is being imported from China, right? It's not coming from cancer patients taking them for their pain. Do you want to have people living in agony in favor of trying to stop idiotic drug abusers from accidentally killing themselves?

a significant percentage of those drug abusers got started because some drug company convinced doctors to prescribe them addictive pain killers to begin with.

[bush_cheney2004]

1 hour ago, ?Impact said:

a significant percentage of those drug abusers got started because some drug company convinced doctors to prescribe them addictive pain killers to begin with.

 

So what ?    They are still drug abusers.   Prescription drugs come with all kinds of warnings, including risk for addiction.  

Stupid is as stupid does...choose wisely.